肝中静脉的解剖结构：在活体肝移植中的应用
Anatomy of the middle hepatic vein: applications to living donor liver transplantation.
作者信息
Matsubara Katsuhiho, Cho Akihiro, Okazumi Shinichi, Makino Harufumi, Mochizuki Ryoyu, Shuto Kiyohiko, Kudo Hidehiro, Tohma Takayuki, Gunji Hisashi, Hayano Koichi, Yanagawa Noriyuki, Ochiai Takenori
机构信息
Department of Frontier Surgery, Graduate School of Medicine, Frontier Medical Engineering, Chiba University, Chiba, Japan.
出版信息
Hepatogastroenterology. 2006 Nov-Dec;53(72):933-7.
BACKGROUND/AIMS: In living donor liver transplantation, right lobe graft without a middle hepatic vein (MHV) results in potential venous congestion in the anterior segment, while transplantation with MHV represents an important ethical issue from the perspective of donor safety. The present study assessed ramification patterns of the MHV and relationships between hepatic venous drainage of the anterior and medial segments, to plan optimal harvesting of the right lobe as a graft.
METHODOLOGY
The authors reviewed 102 patients with normal livers who underwent contrast-enhanced multi-detector row CT.
RESULTS
The hepatic vein that drained S4sup (V4sup) joined only the left hepatic vein (LHV) in 60 patients (58%), only the MHV in 25 (25%), and both LHV and MHV in 17 (17%). Both V4sup and the hepatic vein that drained S8 (V8) joined the MHV in 42 patients (42%), and V8 joined proximal to V4sup in 18 of these 42 patients.
CONCLUSIONS
In donation of a right lobe graft including MHV, preservation of V4sup in the remnant donor liver seems possible in most donors.
背景/目的：在活体肝移植中，不带肝中静脉（MHV）的右叶移植物会导致前段潜在的静脉淤血，而带MHV进行移植从供体安全角度来看是一个重要的伦理问题。本研究评估了MHV的分支模式以及肝前段和肝中段静脉引流之间的关系，以规划右叶移植物的最佳获取方式。
方法
作者回顾了102例接受多排螺旋CT增强扫描的正常肝脏患者。
结果
引流S4上区（V4上）的肝静脉仅汇入左肝静脉（LHV）的有60例患者（58%），仅汇入MHV的有25例（25%），同时汇入LHV和MHV的有17例（17%）。V4上和引流S8区的肝静脉（V8）均汇入MHV的有42例患者（42%），在这42例患者中，有18例V8在V4上的近端汇入。
结论
在捐献包含MHV的右叶移植物时，大多数供体的剩余供肝中保留V4上似乎是可行的。
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